Increasing Value for Vermonters Vermont Senate Finance Committee - - PowerPoint PPT Presentation
The heart and science of medicine. UVMHealth.org The University of Vermont Health Network: Increasing Value for Vermonters Vermont Senate Finance Committee February 10, 2016 Overview Introductions Progress of health reform/cost
The heart and science of medicine.
UVMHealth.org
Vermont Senate Finance Committee February 10, 2016
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Network and CEO, UVM Medical Center
for Quality and Operational Effectiveness, UVM Medical Center
Coordinator, Central Vermont Medical Center
Network
Medical Center
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UVMHealth.org
UVMHealth.org
Anna Noonan, RN, Vice President, The Jeffords Institute for Quality and Operational Effectiveness
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Infection Prevention EFAP & Employee Health Management Office of Patient and Family Advocacy Data Analytics Community Health Team Regulatory Affairs Patient Safety Community Health Improvement
Jeffords Institute for Quality
Research Continuous Systems Improvement Outreach Services
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delivery system.
the “value” of the healthcare services provided in our region.
state, and federal health care related regulations.
the organization.
at the University of Vermont Medical Center and its affiliated partners.
the health of our population and our community.
populations we serve.
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Source: CMS National Provider Call
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4 Year Award Winner in Supply Chain: Ranked 1st in 2012 Among AMC’s and Ranked 2nd from 2013 -> 2015
from an HAI each year.
U.S. healthcare system billions of dollars each year University of Vermont Medical Center’s “ Getting to Zero” Infection Prevention Initiatives
Evidenced based practice
medical record
maintenance bundle
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50 100 150 200 250 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Primary Bloodstream Infection Count - Nosocomial 1987 - 2015
https://youtu.be/d3XkWRjk-CU
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Washington, DC, November 21, 2014 – The U.S. Department of Health and Human Services (HHS), the Association for Professionals in Infection Control and Epidemiology (APIC), and the Society for Healthcare Epidemiology of America (SHEA) today recognized the University of Vermont Medical Center with the 2014 Partnership in Prevention Award for achieving sustainable improvements toward eliminating healthcare- associated infections (HAIs).*
*Excerpt from 2014 HHS Press Release
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Intensive Care and Neonatal Intensive Care Units from baseline in 2010
reduced variation in practice resulting in:
– 81% reduction in total joint infection rates – 62% reduction in spinal fusion infection rates
(CDC) Dialysis Bloodstream Infection Prevention Collaborative and reduced access-related bloodstream infections in six outpatient dialysis centers by 83%.
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The Experts Were Wrong About the Best Places for Better and Cheaper Health Care
By KEVIN QUEALY and MARGOT SANGER-KATZ DEC. 15, 2015
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UVMHealth.org
Justin Stinnett-Donnell, MD, Value Care Initiative Coordinator, Central Vermont Medical Center
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Evidence for the Physician Information for the Patient
– Dr. Parsons asked the medical faculty of each department to submit ideas for choosing wisely type projects.
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Cardiology Monitor Procedural Radiation Dermatology CXR and labs for melanoma
Gastroenterology No Elective Colo if PCI < 6 months
Pulmonology COPD Referrals without Dx Rheumatology Repeat Pos. ANA Rheumatology DXA Scan Usage / Risk Factors Cardiology Reduce Radiotracer Use ID /Pulm / Palliative Reduce Daily / Duplicate Labs Oncology CA – 125 Usage Guidelines Palliative Care Early Introduction of PC Cardiology Offer Stress Echo’s to Inpatients Endocrinology TgAB lab limited to endocrine
Endocrinology Salivary cortisol only for Cushing’s
Gastroenterology No Elective Colo if age > 75 Critical Care Reduce daily CXR Critical Care Decrease Blood Product usage Critical Care Reduce i-Ca. testing Palliative Care Outpatient Palliative Care Plan Pulmonology Spirometry With Bronchodilator Infectious Disease Guidelines for Blood Cx’s Oncology Improve Thora/ Paracentesis
Noncontroversial and evidence-based Measure available electronically Meaningful outcome (reduce harm, reduce cost, improved patient outcome or experience = value add) Potential intervention to not increase physician workload
Nephrology BUN/Cr. On ESRD Patients
Medicine Operations And Efficiency Committee
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Rheumatology Repeat Pos. ANA Rheumatology DXA Scan Usage / Risk Factors Gastroenterology No Elective Colo if age > 75 Nephrology BUN/Cr. On ESRD Patients
FY 2013
602 Repeat (+) ANA’s in 2.5 years 1070 DXA on target population Over 4 years Rate Less then Expected 3850 Cr. Checked in 2 years
Gastroenterology Reduce Repeat Labs Critical Care Reduce Daily CXR Cardiology Reduce Redundant Echos Oncology Staging of Breast Cancer
FY 2014
150 Repeat Hep A 138 Repeat Hep C 873 CXR _ 1000 Vented Patient Days 18.2% of echocardiograms were repeats within one year
35 of 74 CT-bone or PET images non-indicated by ASCO Criteria Hospitalist Reduce Folate Testing Cardiology Reduce CK/MB Cardiology Evaluation Troponin Testing
FY 2015
27/4,468 (0.6%) Folate tests were deficient 19,790 CK/MB checked in 1 year Data under evaluation
Nephrology Reduce Blood Draws on ESRD
87% of labs not drawn in Dialysis
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Do we have an
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Clinical Champion Resident Laboratory HVC Coordinators PRISM Nursing Data Analytics
Jeffords Project Manager
Objective: Reduce automated morning CXR’s on intubated patients.
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↓ Radiation Exposure ↓ Patient Discomfort ↓ Sedative medications ↑ Sleep ↓ Delirium ↓ Radiology Tech Time ↓ Radiologist Time ↓ Nursing Time ↓ Image storage costs
Gilman Allen, MD Ryan Clouser, DO Ben Keveson, MD
Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 CXR # Saved
CXR $
349,388 -$23,769 -$42,028 -$30,852 -$45,766 -$41,471 -$50,894 -$54,705 -$59,904
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– Can this be scaled?
the Department of Medicine for future projects
departments at UVM Medical Center
Network
public domain
33 Alice Hyde Champlain Valley Elizabethtown Central Vermont UVM MC
The heart and science of medicine.
UVMHealth.org
Primary Investigators: Alan Repp, MD Cy Jordan, MD
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award – part of State Innovation Model Grant (CMS)
– Grant title: Vermont Hospital Medicine Choosing Wisely™ Project – PI: Cy Jordan, MD and Allen Repp, MD
– Over the course of 2 year grant duration, undertake two projects focused on reducing unnecessary tests and treatments in hospitalized Vermonters
unnecessary lab testing in hospitalized adults
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University of Vermont Medical Center Porter Medical Center Rutland Regional Medical Center Northeastern Vermont Regional Hospital Southwestern Vermont Health Center Central Vermont Medical Center Dartmouth Hitchcock Medical Center Brattleboro Memorial Hospital
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“… many of the traditional strategies used to increase quality—monetary incentives, training, and sharing of best practices, … have little effect. Instead,… companies that take a grassroots, peer- driven approach develop a culture of quality, resulting in employees who make fewer mistakes—and the companies spend far less time and money correcting mistakes.”
https://hbr.org/2014/04/creating-a-culture-of-quality
High Value Care Program:
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intensive
– Sharing and Benchmarking of data is difficult – Best Practices in Decision Support must be built and maintained independently by each institution – Different functionality makes one solution incompatible with other systems
model
up model
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Department of Medicine
Polly Parsons Cardiology David Schneider Martin LeWinter Frederique Keating Critical Care Gil Allen Ryan Clouser Gastroenterology James Vecchio Steven Lidofsky Hospitalist Jason Bartsch Rheumatology Edward Leib Bonita Libman Nephrology Virginia Hood Bette Gilmartin Oncology Marie Wood
Steering Committee
Virginia Hood Justin Stinnett-Donnelly Pamela Stevens Allen Mead
Jeffords Institute for Quality
Anna Noonan Jason Minor Patricia Bouchard Mike Nix Deirdre LaFrance Mike Gianni Cynthia Gagnon Melissa Holman
PRISM
Doug Gentile William Eaton Randy Ensley Alicia Cardoza Merrill Cate Jan Gannon William Eaton
Pathology / Laboratory
Mark Fung Greg Sharp Jill Warrington Jocelyne Stocker Michelle Baker Luke Purvis
GME / Residents / Fellows
Elizabeth Hall Maria Burnett Patrick Hohl Sean McMahon Sadi Raza Samreen Raza Benjamin Keveson Heather Shank Adedayo Fashoyin Tim Leclair Sam Merrill
Radiology
Mike Blakeslee
“I learned that the only easy part of a quality improvement project is the proposal of a seemingly simple idea…the challenge lies in multiple departments collaborating together to achieve a common goal.”
“The High Value Care project provided me a conduit to evolve from a worker bee/resident to becoming an active leader in our
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UVMHealth.org
Todd Keating, Chief Financial Officer, UVM Health Network
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quality, cost management and productivity due to lower reimbursement levels (direct or indirect)
education to improve quality outcomes
above requires a different philosophy that incorporates:
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more for better quality outcomes
strive for better access to drive high quality preventative care
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Annual On-going Cost Improvement
Supply Chain Labor Management Revenue Cycle Overhead Clinical Productivity
Business Reconfiguration Clinical Effectiveness
Scale Product Mix Physician Alignment Service Distribution Consumer Strategy Clinical Variation Care Management Clinical Integration Care Transitions End of Life Care Public Health Capital Allocation
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needed
resource consumption and productivity
wide tool for developing cost at the procedure level (cost accounting) and analyzing service line profitability
multi-year financial forecasts and determining the impact
and network-wide tool for evaluating capital proposals and for tracking spending/future obligations
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and network-wide tool for budget development, variance reporting and productivity monitoring
performance data to foster understanding and decision- making driven by key performance indicators showing trends, rankings, contributions, variances and outliers
and identifies areas of opportunity by comparing current staffing levels against historical, as well as benchmarks
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efficiencies
Investment Managers, Actuaries, Commercial Banking and Pharmacy Benefits Manager as a few examples to reduce overhead costs
productivity
UVMHealth.org
Judy Tartaglia, President and CEO, Central Vermont Medical Center John R. Brumsted, MD, President and CEO, UVM Health Network and CEO, UVM Medical Center
that promotes or restores health, as efficiently and effectively as possible, through:
– Partnering with patients and families, who want an active voice in their care – Collaborating with other providers in our community who share in caring for our patients – Working with social service agencies on issues like housing, transportation and food security that affect health – Leveraging the education and research expertise and the innovations of
commit to moving away from FFS payments to 80% risk- based payments by 2018
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UVMHealth.org
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